Provider Demographics
NPI:1417937749
Name:MOTTER, LARA HUTCHISON (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:HUTCHISON
Last Name:MOTTER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4639 E PALO BREA LN
Mailing Address - Street 2:
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-5822
Mailing Address - Country:US
Mailing Address - Phone:602-460-0899
Mailing Address - Fax:480-515-0175
Practice Address - Street 1:4639 E PALO BREA LN
Practice Address - Street 2:
Practice Address - City:CAVE CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85331-5822
Practice Address - Country:US
Practice Address - Phone:602-460-0899
Practice Address - Fax:480-515-0175
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP1887235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist